Health Bill [HL]

Amendment 3 would place the principles of the NHS Plan, published in 2000, in the Bill. It would also mean that the principles published in the NHS Constitution on 21 January and all future versions of the constitution should be adjusted to reflect this set of principles. I appreciate that in tabling this amendment the noble Earl wishes to ensure that we do not lose sight of the principles set out in the NHS Plan. I reassure him that no principles from the NHS Plan have gone missing from the constitution. Where they do not appear as a principle they are reflected elsewhere, either as a pledge or as a legal right. For example, there is a principle in the NHS Plan that the NHS will respond to the different needs of different populations. That has been translated into a patient right in the constitution: to expect your local NHS to assess the health requirements of local communities and to put in place the services considered necessary to meet those needs. The second principle that the noble Earl referred to was about valuing staff, which was also touched on by the noble Earl, Lord Listowel. Obviously, staff are the NHS’s most important asset, and we are fortunate to have 1.3 million staff working in it. The constitution reflects that by making a number of pledges to the staff, including pledges to provide staff with personal development, access to appropriate training and line management support, and pledges to provide support and opportunities for staff to maintain their health and well-being. The constitution’s third principle also reflects the importance of education and training in the development of staff. The noble Earl also raised the issue of the difference in the wording between ““patients”” and ““public”” and why we have changed one to the other. ““Patients”” applies to people already accessing the health service, but the NHS is for everyone, even for the well, in order to keep them well. The revised wording reflects that. The noble Baroness, Lady Cumberlege raised the issue of whether the NHS will provide a comprehensive service. The first principle of the constitution confirms that. The NHS will provide a comprehensive service, and it is the Government and the constitution that are trying to secure that, at least for the next 10 years. That is based on the Health Act 2006. The noble Baroness referred to the issue of quality and safety, and I am grateful to her for that. The third principle talks about how the NHS should aspire to the highest standards of excellence and professionalism in the provision of high quality care that is safe, effective and focused on the patient’s experience. We have used these definitions, and I have no doubt that we shall be debating them when we discuss some of your Lordships’ amendments on the quality account. The constitution also sets out a patient’s right to expect organisations to meet the required levels of quality and to make every effort to improve the quality of healthcare they provide. We hope that the Bill meets the aspirations of not just the high quality that the staff wish to provide, but also the high-quality care that the patients expect from the NHS. The noble Baroness, Lady Finlay, also referred to the NHS Constitution and said that it applied only to England. The devolved Administrations are of course free to make their own decisions, but I should like to reassure her that although the constitution applies only to England, none of the other devolved Administrations have moved away from the core principles on which the NHS was founded in 1948. This is our attempt to ensure that these are maintained. It has been suggested that the constitution will change every three years. That is incorrect. The constitution will not be renewed for at least 10 years; it is the handbook that will be reviewed every three years. The noble Lord, Lord Walton, raised the issue of education of healthcare professionals and the research aspects of it. I think I have covered the educational aspect of it. The third principle in the constitution recognises the importance of innovation and the promotion of research, but not at the expense of confidentiality. I return to the point raised by the noble Baroness, Lady Barker, and the noble Lord, Lord Stoddart. Only healthcare professionals and people who owe the same duty of confidentiality as healthcare professionals are legally allowed to process sensitive personal information for medical and research purposes. Healthcare professionals are qualified and registered staff, such as doctors and nurses. Established NHS practice uses patient information when necessary to support research. We have seen many fruits of that research over the past 60 years, and we lead globally in many areas of research because of the NHS and its funding principles. The noble Lord, Lord Stoddart, asked whether we could be clearer about funding the NHS. The document published with the constitution, the Statement of NHS Accountability, states on its first page: "““The NHS in England currently spends around £100 billion a year—equivalent to nearly £2,000 per person on average.””" That is in the constitution, and I have no doubt that that will help many who use the NHS to understand the value of the care they receive. I reassure the noble Baroness, Lady Barker, that over the summer the constitution and the principles were consulted on extensively, specifically looking at the 10 NHS planned principles, which we have looked at since 2000. This extensive engagement with key stakeholders, when drawing up the constitution, allowed us to refine the principles set out in the NHS Plan. We now have a set of principles that has the support of patients, the public and the staff. The large majority of respondents to the consultations thought that the principles articulated were broadly right; a small number of improvements were suggested and the final published version of the constitution reflected those comments. It is important to remember why we have chosen not to include any part of the NHS Constitution in the Bill. As the noble Lord, Lord Walton, eloquently said, ““We do not want to create a lawyers’ charter here””. That is why this is a declaratory and not a legal document. I think we can all agree that we would not wish to see decision-making in the NHS become a preserve of the courts. Equally, enshrining the NHS principles in the Bill would set them in stone until primary legislation was changed. While it is certainly not my intention that the principles of the NHS should change in any significant way—indeed, I see these principles as enduring—I also believe that it is important that there is a degree of flexibility, as highlighted by my noble friend Lord Warner, in relation to the NHS as it grows and evolves. So the proposals in Clause 3 for the constitution to be reviewed at least every 10 years following full consultation with relevant groups allow for this degree of flexibility while ensuring that the principles endure. Given my reassurance that the principles from the NHS plan have not been lost and that the principles in the constitution have been subject to a full consultation, I hope that I have convinced the Committee and that the noble Earl, Lord Howe, feels able to withdraw his amendment.